Individual
MR. EVAN MICHAEL BRADLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MS, BCBA, LBS
Contact information
Practice address
4 NESHAMINY INTERPLEX DR STE 204, FEASTERVILLE TREVOSE, PA 19053-6940
(267) 520-3301
Mailing address
1320 W SOMERVILLE AVE APT 1019, PHILADELPHIA, PA 19141-2970
(267) 972-1717
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
BH003470
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1-17-25207
BEHAVIOR ANALYSIS CERTIFICATION BOARD
—
01
—
BH003470
LICENSED BEHAVIOR SPECIALIST
PA
Enumeration date
07/12/2017
Last updated
07/12/2017
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